Abstract:
BACKGROUND:Through major efforts to reduce costs and expand access to antiretroviral therapy worldwide, widespread delivery of effective treatment to people living with HIV/AIDS is now conceivable even in severely resource-constrained settings. However, the potential epidemiologic impact of treatment in the context of a broader strategy for HIV/AIDS control has not yet been examined. In this paper, we quantify the opportunities and potential risks of large-scale treatment roll-out. METHODS AND FINDINGS:We used an epidemiologic model of HIV/AIDS, calibrated to sub-Saharan Africa, to investigate a range of possible positive and negative health outcomes under alternative scenarios that reflect varying implementation of prevention and treatment. In baseline projections, reflecting "business as usual," the numbers of new infections and AIDS deaths are expected to continue rising. In two scenarios representing treatment-centered strategies, with different assumptions about the impact of treatment on transmissibility and behavior, the change in the total number of new infections through 2020 ranges from a 10% increase to a 6% reduction, while the number of AIDS deaths through 2020 declines by 9% to 13%. A prevention-centered strategy provides greater reductions in incidence (36%) and mortality reductions similar to those of the treatment-centered scenarios by 2020, but more modest mortality benefits over the next 5 to 10 years. If treatment enhances prevention in a combined response, the expected benefits are substantial-29 million averted infections (55%) and 10 million averted deaths (27%) through the year 2020. However, if a narrow focus on treatment scale-up leads to reduced effectiveness of prevention efforts, the benefits of a combined response are considerably smaller-9 million averted infections (17%) and 6 million averted deaths (16%). Combining treatment with effective prevention efforts could reduce the resource needs for treatment dramatically in the long term. In the various scenarios the numbers of people being treated in 2020 ranges from 9.2 million in a treatment-only scenario with mixed effects, to 4.2 million in a combined response scenario with positive treatment-prevention synergies. CONCLUSIONS:These analyses demonstrate the importance of integrating expanded care activities with prevention activities if there are to be long-term reductions in the number of new HIV infections and significant declines in AIDS mortality. Treatment can enable more effective prevention, and prevention makes treatment affordable. Sustained progress in the global fight against HIV/AIDS will be attained only through a comprehensive response.
journal_name
PLoS Medjournal_title
PLoS medicineauthors
Salomon JA,Hogan DR,Stover J,Stanecki KA,Walker N,Ghys PD,Schwartländer Bdoi
10.1371/journal.pmed.0020016keywords:
subject
Has Abstractpub_date
2005-01-01 00:00:00pages
e16issue
1eissn
1549-1277issn
1549-1676pii
04-PLME-RA-0177R1journal_volume
2pub_type
杂志文章相关文献
PLOS MEDICINE文献大全abstract:BACKGROUND:Experimental studies have suggested that dipeptidyl peptidase-4 (DPP-4) inhibitors provide cardiovascular protective effects. We performed a randomized study to evaluate the effects of sitagliptin added on to the conventional therapy compared with conventional therapy alone (diet, exercise, and/or drugs, exc...
journal_title:PLoS medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1371/journal.pmed.1002051
更新日期:2016-06-28 00:00:00
abstract:BACKGROUND:Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of avail...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000241
更新日期:2010-03-02 00:00:00
abstract:BACKGROUND:Although it has long been appreciated that ovarian carcinoma subtypes (serous, clear cell, endometrioid, and mucinous) are associated with different natural histories, most ovarian carcinoma biomarker studies and current treatment protocols for women with this disease are not subtype specific. With the emerg...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050232
更新日期:2008-12-02 00:00:00
abstract:BACKGROUND:Oncolytic viruses hold much promise for clinical treatment of many cancers, but a lack of systemic delivery and insufficient tumor cell killing have limited their usefulness. We have previously demonstrated that vaccinia virus strains are capable of systemic delivery to tumors in mouse models, but infection ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040353
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Policymakers worldwide are considering requiring warnings for sugary drinks. A growing number of experimental studies have examined sugary drink warnings' impacts, but no research to our knowledge has synthesized this literature. To inform ongoing policy debates, this study aimed to identify the effects of s...
journal_title:PLoS medicine
pub_type: 杂志文章,meta分析
doi:10.1371/journal.pmed.1003120
更新日期:2020-05-20 00:00:00
abstract:BACKGROUND:Many mathematical models have investigated the impact of expanding access to antiretroviral therapy (ART) on new HIV infections. Comparing results and conclusions across models is challenging because models have addressed slightly different questions and have reported different outcome metrics. This study co...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001245
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. Our aim was to determine whether women with PEC or GH during pregnancy have an increased risk of developing diabetes after pregnancy, and whether the pr...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001425
更新日期:2013-01-01 00:00:00
abstract::In a Perspective, Hilary Seligman and Sanjay Basu discuss future scenarios of food assistance programs to improve population health in a changing political environment. ...
journal_title:PLoS medicine
pub_type: 评论,杂志文章
doi:10.1371/journal.pmed.1002662
更新日期:2018-10-02 00:00:00
abstract::Considerable progress has been made in reducing maternal, newborn, and child mortality worldwide, but many more deaths could be prevented if effective interventions were available to all who could benefit from them. Timely, high-quality measurements of intervention coverage--the proportion of a population in need of a...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.1001423
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:The anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab's high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone r...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002067
更新日期:2016-08-09 00:00:00
abstract:BACKGROUND:Research needs to be reported transparently so readers can critically assess the strengths and weaknesses of the design, conduct, and analysis of studies. Reporting guidelines have been developed to inform reporting for a variety of study designs. The objective of this study was to identify whether there is ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001069
更新日期:2010-08-01 00:00:00
abstract::A major challenge in monitoring universal health coverage (UHC) is identifying an indicator that can adequately capture the multiple components underlying the UHC initiative. Effective coverage, which unites individual and intervention characteristics into a single metric, offers a direct and flexible means to measure...
journal_title:PLoS medicine
pub_type: 杂志文章,评审
doi:10.1371/journal.pmed.1001730
更新日期:2014-09-22 00:00:00
abstract:BACKGROUND:For more than a decade, most parts of Somalia have not been under the control of any type of government. This "failure of state" is complete in the central and southern regions and most apparent in Mogadishu, which had been for a long period in the hands of warlords deploying their private militias in a batt...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0040341
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Hip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investig...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0050179
更新日期:2008-09-30 00:00:00
abstract::Philippe Calain discusses the health and environmental hazards of extractive industries like mining and explores the tensions that arise when medical humanitarian organizations are called to intervene in emergencies involving the extractive sector. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001302
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Socioeconomic adversity in early life has been hypothesized to "program" a vulnerable phenotype with exaggerated inflammatory responses, so increasing the risk of developing type 2 diabetes in adulthood. The aim of this study is to test this hypothesis by assessing the extent to which the association between...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001479
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:HIV self-testing (HIVST) may play a role in addressing gaps in HIV testing coverage and as an entry point for HIV prevention services. We conducted a cluster randomized trial of 2 HIVST distribution mechanisms compared to the standard of care among female sex workers (FSWs) in Zambia. METHODS AND FINDINGS:T...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1002442
更新日期:2017-11-21 00:00:00
abstract:BACKGROUND:Growing prevalence of atrial fibrillation (AF) in the ageing population and its associated life-changing health and resource implications have led to a need to improve its early detection. Primary care is an ideal place to screen for AF; however, this is limited by shortages in general practitioner (GP) reso...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1003197
更新日期:2020-07-17 00:00:00
abstract::[This corrects the article DOI: 10.1371/journal.pmed.1002511.]. ...
journal_title:PLoS medicine
pub_type: 杂志文章,已发布勘误
doi:10.1371/journal.pmed.1002608
更新日期:2018-06-26 00:00:00
abstract:BACKGROUND:Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS:Using data from the Collaboration of Observational HIV E...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001194
更新日期:2012-01-01 00:00:00
abstract::The PLOS Medicine editors discuss the new extension to the PRISMA reporting guidelines, PRISMA for Equity (PRISMA-E), and why it is relevant to the journal and to health research more generally. ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1001334
更新日期:2012-10-01 00:00:00
abstract::Drawing upon interviews with experts and a review of the literature, Gavin Yamey proposes a new framework for scaling up global health interventions. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001049
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estim...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1001558
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. METHODS AND FINDINGS:A total of 3,274 uncircumcised men, aged 18-24 y, were randomiz...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.0020298
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Malaria and hypertension are major causes of maternal mortality in tropical countries, especially during first pregnancies, but evidence for a relationship between these syndromes is contradictory. METHODS AND FINDINGS:In a cross-sectional survey of Tanzanian parturients, the rate of hypertension was simila...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0030446
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. METHOD AND FINDINGS:We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 wo...
journal_title:PLoS medicine
pub_type: 杂志文章,随机对照试验
doi:10.1371/journal.pmed.1001036
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Evidence on where in the hypertension care process individuals are lost to care, and how this varies among states and population groups in a country as large as India, is essential for the design of targeted interventions and to monitor progress. Yet, to our knowledge, there has not yet been a nationally rep...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1002801
更新日期:2019-05-03 00:00:00
abstract:BACKGROUND:The proteases (secretases) that cleave amyloid-beta (Abeta) peptide from the amyloid precursor protein (APP) have been the focus of considerable investigation in the development of treatments for Alzheimer disease. The prediction has been that reducing Abeta production in the brain, even after the onset of c...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.0020355
更新日期:2005-12-01 00:00:00
abstract::In this month's editorial, PLOS Medicine Editorial Board member Rachel Jewkes identifies challenges that the violence prevention research community faces in substantially reducing violence against women and girls over the next 30 years. Please see later in the article for the Editors' Summary. ...
journal_title:PLoS medicine
pub_type: 社论
doi:10.1371/journal.pmed.1001761
更新日期:2014-11-25 00:00:00
abstract::Leo Sher and colleagues discuss recent research on interventions to prevent secondary suicide and discuss the additional research that is needed. ...
journal_title:PLoS medicine
pub_type: 杂志文章
doi:10.1371/journal.pmed.1000271
更新日期:2010-06-01 00:00:00